Cost-effectiveness of ultrahigh-resolution photon-counting detector coronary CT angiography for the evaluation of stable chest pain.

Milán Vecsey-Nagy, Tilman Emrich, Giuseppe Tremamunno, Dmitrij Kravchenko, Muhammad Taha Hagar, Gerald S Laux, U Joseph Schoepf, Jim O'Doherty, Melinda Boussoussou, Bálint Szilveszter, Pál Maurovich-Horvat, Thomas Kroencke, Ismail Mikdat Kabakus, Pal Spruill Suranyi, Akos Varga-Szemes, Josua A Decker
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Abstract

Background: The increased specificity of ultrahigh-resolution (UHR) photon-counting detector (PCD)-CT over energy-integrating detector (EID)-CT for coronary CT angiography (CCTA) could defer unwarranted downstream tests. The objective of the study was to simulate the cost-effectiveness of UHR CCTA in stable chest pain patients with coronary calcifications.

Methods: A decision and simulation model was developed using Monte Carlo simulations with 1000 bootstrap resamples to estimate the costs associated with PCD-CT in lieu of EID-CT for CCTA and the referral for subsequent testing. The model was constructed using the diagnostic accuracy metrics of 55 coronary lesions in patients who underwent CCTA on both CT systems and subsequent invasive coronary angiography (ICA). Sensitivity and specificity were defined for each Coronary Artery Disease Reporting and Data System category. The aggregate healthcare expenditures were derived from the hospital billing system.

Results: Assuming a projected cohort of 15,000 patients over the lifetime of the PCD-CT, its implementation resulted in a 18.9 ​% reduction in the number of functional follow-up tests (6330.3 ​± ​59.5 vs. 5135.7 ​± ​60.6, p ​< ​0.001), a 6.0 ​% reduction in performed ICAs (1447.7 ​± ​36.2 vs. 1360.2 ​± ​34.7, p ​< ​0.001), and a 9.4 ​% decrease in major procedure-related complications. Over a 10-year expected life expectancy, PCD-CT led to an average cost saving of $794.50 ​± ​18.50 per patient and an overall cost difference of $11,917,500 ​± ​4,350,169.

Conclusions: PCD-CT has the potential to reduce the financial burden on healthcare systems and procedure-related complications for stable chest pain patients with coronary calcification when compared to EID-CT.

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超高分辨率光子计数探测器冠状动脉 CT 血管造影用于评估稳定型胸痛的成本效益。
背景:在冠状动脉 CT 血管造影(CCTA)中,超高分辨率(UHR)光子计数探测器(PCD)-CT 比能量积分探测器(EID)-CT 的特异性更高,可以推迟不必要的下游检查。本研究的目的是模拟 UHR CCTA 在冠状动脉钙化的稳定型胸痛患者中的成本效益:方法:使用蒙特卡罗模拟法开发了一个决策和模拟模型,并进行了 1000 次引导重采样,以估算 PCD-CT 代替 EID-CT 进行 CCTA 和转诊后续检查的相关成本。该模型是利用在两种 CT 系统上进行 CCTA 和随后进行有创冠状动脉造影 (ICA) 的患者中 55 个冠状动脉病变的诊断准确性指标构建的。为每个冠状动脉疾病报告和数据系统类别定义了敏感性和特异性。医疗支出总额来自医院账单系统:结果:假定 PCD-CT 使用期内预计有 15,000 名患者,其实施可使功能性随访检查的次数减少 18.9%(6330.3 ± 59.5 vs. 5135.7 ± 60.6,p 结论:PCD-CT 有潜力为冠心病患者提供更有效的治疗:与 EID-CT 相比,PCD-CT 有可能减轻医疗系统的经济负担,并减少冠状动脉钙化的稳定型胸痛患者的手术相关并发症。
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Cost-effectiveness of ultrahigh-resolution photon-counting detector coronary CT angiography for the evaluation of stable chest pain. Association of coronary inflammation with plaque vulnerability and fractional flow reserve in coronary artery disease. Prognostic value of left ventricular mass measured on coronary computed tomography angiography. Coronary computed tomography angiography for the diagnosis of significant left main coronary artery disease. Diagnostic performance of fully automatic coronary CT angiography-based quantitative flow ratio.
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